Survival Tips for a Less-Than-Ideal First Job

[LexieGirl0491]

Hi, everybody. I am a long-time lurker here, but this is my first time posting outside of the Physician Assistant Schools boards. I apologize ahead of time if my post is a bit of a mess...I have had a rough morning and am still trying to recover.

     I graduated from my PA program in May of this year. After months and months and looking and applying for jobs, I finally found one at a local urgent care. I was apprehensive at first because I never truly wanted to work in urgent care, but it was the only job for which I received an offer. I have now worked there for a little over a month. My "orientation" for the most part has been a disorganized mess, with me being passed around from preceptor to preceptor and never quite knowing what their expectations for me were. This morning I received a text from my preceptor that there were some things that "needed to change" and that she needed to discuss with me; a little while later I found myself on a call with her and HR. She stated that she had concerns about my initiative and eagerness to see patients. Despite repeatedly telling my preceptors that I am a new graduate with fears about the level of independence that this company is expecting me to have, I feel as if nobody is listening or respecting me enough to take me seriously. My mental health is severely suffering as a result of all of this, and I am extremely worried about my ability to do this job well and care for my patients.

     Again, I am sorry for the lack of detail in my post. I can provide examples of things that have happened if anybody would like me to. It's just incredibly difficult for me to put my thoughts together right now, and I am really just searching for advice on how to handle and hopefully keep this job. Any words of wisdom that you all may have would be greatly appreciated. Thank you in advance.

[ventana]

so

 

welcome to medicine

welcome to corporate medicine

welcome to urgent care

 

 

 

It all sort of stinks and UC is not a place for a new grad, but you have the job and you need to make the most of it.

He comments on your initiative is the most concerning.  You need to be working harder then anyone else, trying and showing you care and are doing your very best.  I recently had a student who appeared to simply not care.  When confronted he said he did, but then his behaviors barely said he gave a tiny bit.  The point it you need to SHOW them you are trying, there might be hope but it is tough out there right now.

 

Where are you located?

 

[LexieGirl0491]

Thank you for your reply.

I am located in Louisiana. When I was still looking for a job, there were very few in the city in which I actually live. The clinics at which I am now working are located about an hour and a half to two hours away from my home, so I basically have been living out of my car and different hotels. This has also made my situation especially difficult.

I think that her comments on my initiative come mostly from me not being fast enough. I knew that this would be an issue for me in a specialty like urgent care, which is why I never wanted to work there. I have OCD, so I tend to be a perfectionist and slow at doing things. This is especially true when I am new at something and still learning. She also stated today that when the nurse comes out of the room after rooming a patient, I should be jumping up, asking the nurse why the patient is here, and running into the room. I do make an effort to do this as much as possible, but sometimes my preceptor just beats me to it. There are also some patients that I am still a little apprehensive about seeing on my own. Another concern that she expressed was that I should be seeing every patient that comes in at this point in my training. As far as this goes, I did not know that this was what was expected of me. She stated on my most recent weekly evaluation that I should be seeing at least twenty patients per shift. Seeing every patient that comes in could mean that I am seeing up to fifty patients per day on some shifts.

[CAdamsPAC]

3 hours ago, LexieGirl0491 said:

Hi, everybody. I am a long-time lurker here, but this is my first time posting outside of the Physician Assistant Schools boards. I apologize ahead of time if my post is a bit of a mess...I have had a rough morning and am still trying to recover.

     I graduated from my PA program in May of this year. After months and months and looking and applying for jobs, I finally found one at a local urgent care. I was apprehensive at first because I never truly wanted to work in urgent care, but it was the only job for which I received an offer. I have now worked there for a little over a month. My "orientation" for the most part has been a disorganized mess, with me being passed around from preceptor to preceptor and never quite knowing what their expectations for me were. This morning I received a text from my preceptor that there were some things that "needed to change" and that she needed to discuss with me; a little while later I found myself on a call with her and HR. She stated that she had concerns about my initiative and eagerness to see patients. Despite repeatedly telling my preceptors that I am a new graduate with fears about the level of independence that this company is expecting me to have, I feel as if nobody is listening or respecting me enough to take me seriously. My mental health is severely suffering as a result of all of this, and I am extremely worried about my ability to do this job well and care for my patients.

     Again, I am sorry for the lack of detail in my post. I can provide examples of things that have happened if anybody would like me to. It's just incredibly difficult for me to put my thoughts together right now, and I am really just searching for advice on how to handle and hopefully keep this job. Any words of wisdom that you all may have would be greatly appreciated. Thank you in advance.

Where is your Supervising Physician in this clinic? Professional issues and concerns about patient care should involve them not HR!.

[CAdamsPAC]

12 minutes ago, LexieGirl0491 said:

Thank you for your reply.

I am located in Louisiana. When I was still looking for a job, there were very few in the city in which I actually live. The clinics at which I am now working are located about an hour and a half to two hours away from my home, so I basically have been living out of my car and different hotels. This has also made my situation especially difficult.

I think that her comments on my initiative come mostly from me not being fast enough. I knew that this would be an issue for me in a specialty like urgent care, which is why I never wanted to work there. I have OCD, so I tend to be a perfectionist and slow at doing things. This is especially true when I am new at something and still learning. She also stated today that when the nurse comes out of the room after rooming a patient, I should be jumping up, asking the nurse why the patient is here, and running into the room. I do make an effort to do this as much as possible, but sometimes my preceptor just beats me to it. There are also some patients that I am still a little apprehensive about seeing on my own. Another concern that she expressed was that I should be seeing every patient that comes in at this point in my training. As far as this goes, I did not know that this was what was expected of me. She stated on my most recent weekly evaluation that I should be seeing at least twenty patients per shift. Seeing every patient that comes in could mean that I am seeing up to fifty patients per day on some shifts.

Sounds like they have pretty unrealistic expectation of a new grad.     "Louisiana physician assistants (PAs) may perform medical services under the supervision of a physician and pursuant to a written document outlining the level and method of supervision. The supervision agreement is to be reviewed annually." Did you receive this document and discuss it with you SP?

Edited December 7, 2020 by CAdamsPAC

[LexieGirl0491]

4 minutes ago, CAdamsPAC said:

Where is your Supervising Physician in this clinic? Professional issues and concerns about patient care should involve them not HR!.

I have no idea. I only know his name. I have a feeling that I will never actually meet him. I do not even have a way of contacting him.

[CAdamsPAC]

1 minute ago, LexieGirl0491 said:

I have no idea. I only know his name. I have a feeling that I will never actually meet him. I do not even have a way of contacting him.

I suggest that you sit down and read the PA Practice Laws for your state. I suspect that your SP may be uncomfortable with your being pushed to practice outside of your clinical comfort zone. Are you working under probation as a new employee?

[LexieGirl0491]

5 minutes ago, CAdamsPAC said:

I suggest that you sit down and read the PA Practice Laws for your state. I suspect that your SP may be uncomfortable with your being pushed to practice outside of your clinical comfort zone. Are you working under probation as a new employee?

I believe so. The orientation period for a new graduate is traditionally eight weeks long...However, I am constantly reminded that this is only "traditionally" the case and that I can be released from training as soon as my preceptor wants me to be. I talked to another new hire who was also a recent graduate, and he said that his training was only about two weeks long.

[CAdamsPAC]

4 minutes ago, LexieGirl0491 said:

I believe so. The orientation period for a new graduate is traditionally eight weeks long...However, I am constantly reminded that this is only "traditionally" the case and that I can be released from training as soon as my preceptor wants me to be. I talked to another new hire who was also a recent graduate, and he said that his training was only about two weeks long.

I think you need to actually see the document stating standards for new hire orientation or probation, along with actually speaking with the physician responsible for the care you render.

 

[ventana]

I have been out 18 years

 

I would NEVER try to see 50 patients in a shift, never ever

 

this is a set up to fail, might want to do your best, realize that if you screw up and kill someone or hurt them only a few months our of school you can likely hang the employer and your SP out to dry (sad but true)

Might start looking for another job ASAP

[ANESMCR]

I don’t know you. I’ll give you the benefit of doubt and assume you’re hard working and intelligent so we can bypass the old school suck it up talk. If they’re not willing to train you appropriately, do not treat you with respect, or place your license and/or patients in danger; and if you’re financially capable, simply leave before it gets worse. Find another job that you can at least kind of enjoy. 

[EMEDPA]

3 hours ago, ventana said:

I have been out 18 years

 

I would NEVER try to see 50 patients in a shift, never ever

I have done it and it burned me crispy. Most ever was 60 in 12 hrs with 36-40 being more typical.

This is great advice. Now I rarely see more than 20 in 12 hrs at my busiest clinical site. 

You can't see 5 patients an hr and deliver good care provide adequate documentation. 

[DejaBlu]

I currently work in urgent care, and my first job out of PA school was in urgent care.  It was terrifying.  It was NOT easy as I was the ONLY provider in my clinic when I worked, so everything was solely my responsibility.  Urgent care is very fast and busy.  And since COVID started, the patients are more impatient and not always very nice. Keep your chin up.

One thing that helped me save time and become faster was having a 'working' word document with standard treatment plans and discharge instructions already written.  I just copy and paste them into my EMR and it saves so much time when I do my charting.  We do have templates but I don't always like them.  In the document, I have the most common medications, including alternatives if they were allergic to PCN, sulfa drugs, etc.  I still use this document every day when I work and it is constantly changing and evolving.  I also use my little notebook that I had while I was in school.  I have some really great notes in there.

Another thing that will be a great time saver is to become familiar with pediatric medication dosing. If you don't already have Epocrates downloaded onto your phone, get it now.  They have a pediatric dosing formula.  If you're unsure about dosing, you can always call the pharmacy and ask them to double check.  I had to do that a few times as a new grad and occasionally still do it when my calculations don't seem quite right.  The pharmacists are usually very helpful and willing to help.

Also, you might want to consider getting a subscription to Urgent Care Rap by Hippo Ed.  It's $195 per year but here is a discount code if you want to buy it. I bought the subscription even when I didn't get CME money for it.  I use it all the time and they have 'show notes' that you can print out.    https://hippoed.com/urgentcare/rap/promotion/urgentcare25?grsf=mh461w

Hope this helps!  Stay the course.  It will be hard but you'll learn a lot and you'll be proud of yourself!!!!

[GetMeOuttaThisMess]

How in heaven’s name are you supposed to practice without being able to reach your SP?  That’s why you have a SP.

[DizzyJ]

You need a copy of your SP agreement on hand.  You are legally required to have a means of communication with the SP.

Are your preceptors all PAs?  Would surprise me if they were and they didn't understand expectations of a new grad.

I agree you should be eager and jumping up to see patients, but also taking your time to thoroughly complete exams/charting/medical decision making.  Being expected to see 50 patients as a new grad, or even experienced PA, is bonkers crazy!

You should present confidence in your ability to obtain a history and do a physical even when you have no idea what you are looking for.

This "orientation" time is the time to see all those patients you are apprehensive about seeing, because you have someone there with you.

The expectation of all your preceptors should be to see patients and use them as a resource.  I can see how it would be ideal to have one preceptor, but it is also good to be seeing different practice styles from having more then one preceptor.  

If the job market isn't good your way, then you all you can do is your best while keeping patient safety and your license as top priority.  

[Arthropathy]

If they are inviting HR to the meeting they are already moving towards dismissing you. I would send out resumes now, you owe them nothing.

Edited December 9, 2020 by Arthropathy